Bowel resection

Bowel resection is surgery to remove part of the small intestine, large intestine or both. The large intestine includes the colon, rectum and anus. Depending on which parts of the intestine are removed, a bowel resection may also be called:

a small bowel resection or small intestine resection

a large bowel resection or large intestine resection

a colectomy

Why a bowel resection is done

A bowel resection is done to:

treat cancer in the small intestine, colon, rectum or anus

treat or relieve symptoms of cancer that has spread to the intestine

remove a blockage in the intestine (called a bowel obstruction)

remove as much cancer as possible (called debulking)

remove precancerous conditions before they become cancer (called prophylactic surgery)

remove parts of the colon that are damaged by an inflammatory bowel disease or diverticulitis

fix a tear or hole in the intestine (called a bowel perforation)

Types of bowel resections

Different types of bowel resections are done to remove different parts of the intestine. Each type of bowel resection is named based on what it removes.

Segmental small bowel resection

A segmental small bowel resection removes part of the small intestine. Some of the mesentery (a fold of tissue that supports the small intestine) and lymph nodes in the area may also be removed.

A segmental small bowel resection is used to remove tumours in the lower part of the duodenum, in the jejunum or in the ileum if the cancer is only in these structures or if it has spread just beyond the small intestine.

A right hemicolectomy is used to remove tumours in the right colon, including the cecum and ascending colon. It may also be done to remove tumours of the appendix.

An extended right hemicolectomy removes all of the transverse colon. It may be done to remove tumours in the hepatic flexure or transverse colon.

Transverse colectomy

A transverse colectomy removes the transverse colon.

This surgery may be done to remove a tumour in the middle of the transverse colon when the cancer hasn’t spread to any other parts of the colon. Sometimes an extended right hemicolectomy is done instead.

Left hemicolectomy

A left hemicolectomy removes:

part of the transverse colon

the splenic flexure (the bend in the colon near the spleen)

the descending colon

part of the sigmoid colon

Sigmoid colectomy

A sigmoid colectomy removes the sigmoid colon. It is used to remove tumours in the sigmoid colon.

Low anterior resection

A low anterior resection removes the sigmoid colon and part of the rectum. It is used to remove tumours in the middle or upper part of the rectum.

Proctocolectomy with coloanal anastomosis

A proctocolectomy (also called a proctectomy) removes all of the rectum and part of the sigmoid colon. Coloanal anastomosis joins the remaining colon to the anus.

This surgery is used to remove tumours in the lower part of the rectum. Often a low anterior resection or an abdominoperineal resection is done instead.

Abdominoperineal resection

An abdominoperineal resection removes the rectum, anus, anal sphincter and muscles around the anus. It is used to remove tumours that are close to the anus or have grown into the muscles around the anus.

Subtotal or total colectomy

A colectomy removes part or all of the colon. If most of the colon is removed, it is called a subtotal or partial colectomy. If all of the colon is removed, including the cecum and the appendix, it is called a total colectomy.

A subtotal or total colectomy is done:

when there is cancer on both the right and left sides of the colon

as a way to prevent colorectal cancer (called a prophylactic colectomy) for some people with familial adenomatous polyposis (FAP) or Lynch syndrome (also called hereditary non-polyposis colon cancer or HNPCC)

to remove a colon that is damaged by an inflammatory bowel disease

Depending on the type of colectomy done, the surgeon may also need to do a colostomy or an ileostomy.

Preparing for a bowel resection

Before surgery, tests will be done to check your general health. Blood tests, a chest x-ray and an electrocardiogram (ECG) may be done to check the health of certain organs. You may also have blood tests to check for malnutrition. If you are malnourished, your bowel resection may be postponed until your nutrition improves. Find out more about these tests and procedures and nutrition for people with cancer.

Your healthcare team will tell you if you need to follow a special diet before surgery. They will also tell you when to stop eating and drinking before surgery.

Depending on the type of bowel resection, you may need to empty your intestine before surgery. This usually means taking a laxative 1 to 2 days before surgery. You may also be given cleansing enemas at the hospital.

If you need a colostomy or an ileostomy, your surgeon will usually mark the abdomen where the stoma (opening) will be to make sure it is in a convenient and comfortable place. Your surgeon or healthcare team may also discuss the type of pouch that you will need to use after the surgery. You may be given antibiotics before surgery to help prevent infection.

Approaches to surgery

The surgeon can use an open technique or a laparoscopic technique.

With the open technique, a large cut (incision) is made in the abdomen to reach the intestine.

With the laparoscopic technique, small cuts are made in the abdomen. An endoscope and tools are inserted through the cuts to do the surgery.

The laparoscopic technique tends to have a shorter hospital stay, faster recovery time and less pain at the incision sites. Some people may not be able to have a laparoscopic bowel resection because of the location or stage of the cancer or other factors.

How a bowel resection is done

A bowel resection is done in the hospital using general anesthesia (you will be asleep).

During a bowel resection, the surgeon removes the diseased or damaged part of the intestine. The surgeon also removes some healthy tissue on either side of the diseased or damaged part of the intestine.

Anastomosis

Once part of the intestine is removed, the 2 remaining ends of the intestine are joined together using stitches or staples. This is called an anastomosis.

When all of the large intestine is removed and the anastomosis is between the small intestine and anus, it is called an ileoanal anastomosis. When it is between the colon and anus, it is called a coloanal anastomosis.

The surgeon may form the ileum or colon into a pouch (called a J-pouch) before joining it to the anus. A J-pouch creates a holding place for stool (poop) when the rectum is removed. It helps lower the number of bowel movements the person has and manage the inability to control bowel movements.

In some cases, an anastomosis is not done. One or both ends of the intestine are attached to an opening on the abdomen instead. This procedure is called a colostomy or an ileostomy, depending on the part of the intestine used.

Lymph node dissection

If the bowel resection is being done to remove cancer, the surgeon will also remove at least 12 nearby lymph nodes. Surgery to remove lymph nodes is called a lymph node dissection.

A total mesorectal excision (TME) is a type of lymph node dissection that removes the mesorectum, which is fat surrounding the rectum that contains lymph nodes and blood vessels. A TME is usually done during a bowel resection to remove cancer in the rectum. Some tissue around the tumour is also removed.

Colostomy or ileostomy

Depending on which part of the intestine is diseased and how healthy the rest of the intestine is, the surgeon may need to do a colostomy or an ileostomy after a bowel resection.

A colostomy creates an opening from the colon to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum to the outside of the body through the abdominal wall.

A colostomy or an ileostomy can be temporary or permanent. The doctor may do a temporary colostomy or ileostomy to allow the intestine to rest and heal after surgery. A colostomy or an ileostomy will be permanent if the lower part of the rectum and anal sphincter are removed during the bowel resection.

Side effects

Side effects can happen with any type of surgery, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects of a bowel resection are usually temporary. The side effects that you may have depend mainly on the type of bowel resection done and your overall health. Side effects of a bowel resection include:

After surgery

After a bowel resection, you will need to stay in the hospital for several days. You will be given pain medicines to keep you comfortable. You will be offered clear fluids for 1 to 2 days after surgery. Solid foods will be introduced slowly.

You may be referred to an oncologist if the bowel resection was done to remove cancer.

If you had a colostomy or an ileostomy, a WOC (wound, ostomy and continence) nurse will teach you how to live with and care for the ostomy. Before you go home, the healthcare team or WOC nurse will talk to you about:

Special considerations for children

Preparing children before a test or procedure can help lower their anxiety, increase their cooperation and develop their coping skills. This includes explaining to children what will happen during the test, such as what they will see, feel and hear.

The first part of the small intestine that receives partially digested food from the stomach, absorbs nutrients and passes digested food to the jejunum. The duodenum also receives digestive juices from the pancreas and bile (a yellow-green fluid that helps digest fat) from the liver and gallbladder.

jejunum

The middle part of the small intestine that receives partially digested food from the duodenum, absorbs most nutrients and fat and passes the remaining food matter to the ileum.

ileum

The last part of the small intestine that receives almost completely digested food from the jejunum, absorbs more nutrients and fat, then passes digested food to the large intestine.

cecum

The first part of the large intestine that receives almost completely digested food from the ileum (the last part of the small intestine) and passes it to the colon.

colostomy

A surgical procedure to create a stoma (artificial opening) from the colon to the outside of the body through the abdominal wall.

A colostomy creates a new path for food waste to leave the body after part of the colon or rectum is removed. A special bag (colostomy bag) is attached to the stoma to collect food waste from the colon.

ileostomy

A surgical procedure to create a stoma (artificial opening) from the ileum to the outside of the body through the abdominal wall.

An ileostomy creates a new path for food waste to leave the body after the colon, rectum and part of the small intestine are removed.

endoscope

A thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body.

An endoscope can be flexible or rigid. It may have a tool to remove tissue for examination. Specialized endoscopes may have tools designed to examine or treat specific organs or structures in the body.

Specialized endoscopes are named for the organ or structure they are used to examine or treat.

erectile dysfunction

The consistent inability to achieve or sustain an erection for sexual intercourse, to ejaculate or both.

Also called impotence or male sexual dysfunction.

oncology

The study of cancers, including development, diagnosis, treatment and prevention.

A doctor who specializes in diagnosing and treating cancers is called an oncologist. Different types of oncologists include medical oncologist, surgical oncologist, radiation oncologist, gynecologic oncologist, urologic oncologist and pediatric oncologist.